Waterjet Ablation for Large Prostates with Intravesical Median Lobes

Abstract

Introduction and Objective:

Aquablation of the prostate for the treatment of benign prostatic hyperplasia (BPH) has shown favorable efficacy and safety compared with transurethral resection of the prostate. Herein, we present an instructional video complementing our single institution experience treating large prostates with intravesical median lobes.

Methods:

Retrospective review of patients undergoing Aquablation for BPH between February and September 2019 was performed. Perioperative outcomes were compared between large prostates (volume ≥80 cc) with an intravesical median lobe and small prostates with or without an intravesical median lobe. Bivariable analysis between groups was performed with Fisher's exact test and an unpaired t-test for categorical and continuous variables, respectively.

Results:

Thirty-two patients underwent Aquablation for the study period. Five patients had a large prostate with an intravesical median lobe. The average prostate size was 135 cc (range 90–176 cc). Average preoperative International Prostate Symptom Score 20 (range 3–34) and Q_max 7 mL/s (range 0–11) did not differ between groups. The average number of complications, complications related to blood loss, transfusion rate, and perioperative change in hemoglobin did not differ between groups on bivariable analysis. Treatment time was the only variable on bivariable analysis that was statistically significant between groups (4.89 minutes vs 2.87 minutes; p = 0.0002). Multivariable analysis was not performed secondary to the small sample size within our cohort.

Conclusions:

Our video demonstrates how the technology of Aquablation is utilized to treat large prostates and prostates with median lobes. Our data show that treating large prostates with median lobes is just as safe as treating smaller prostates. When treating larger prostate glands, urologists should expect treatment times to be longer.

No competing financial interests exist.

Runtime of video: 6 mins 32 secs

Presented at the Mid-Atlantic Section of the AUA, 77th Annual Meeting October 26th, 2019 at the Kalahari Resort and Convention Center in Pocono Manor, PA.